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Is psychological trauma a business continuity issue?

The human aspect of business continuity is often forgotten or misunderstood; yet, without healthy employees, business would grind to a halt. Dr Liz Royle and Catherine Kerr look at the subject and, in particular, how organizations should prepare for and respond to traumatic events in the workplace.

The event you’ve carefully prepared for has just happened – a member of staff has been seriously injured by a violent and aggressive visitor to the reception area. She was stabbed before the perpetrator fled the building. Several colleagues witnessed the attack and two were directly threatened by the individual as he left. One has minor cuts. The first aider attempted to help the injured and is left pale, shocked and bloody.

The ripple effect is starting: senior management are asking questions, colleagues are distressed and angry, there are upset customers helplessly standing around, the telephones continue to ring with the usual business, line managers are seeking advice and direction … the theory gained from planning and simulations now becomes real as business continuity processes are applied. But what about ‘people continuity’? How do you respond to an incident that potentially leaves people traumatised?

The example above may seem extreme and it’s tempting to think that psychological trauma is not something you need to think about. In reality, few workplaces are immune to difficult and distressing events.

Traumatic events in the workplace

According to the 2015/16 Crime Survey for England and Wales, there were an estimated 698,000 incidents of violence at work comprising of 329,000 assaults and 369,000 threats.

A sudden death of a colleague can be highly distressing and seriously disrupt the functioning of a team. Where the death comes about during the course of a person’s duties, the impact on the whole organization can be devastating. Death may also result from accidental or natural causes or even suicide. Between 2011 and 2105, the UK Office for National Statistics reported 18,998 suicides among men and women of working age.

Add to these statistics accidents, serious injuries, robberies, acts of terror or environmental hazards and it becomes apparent that most organizations should at least consider psychological risks and how they would handle such incidents.

Many organizations compile a list of events that they consider ‘traumatic’ and create support processes that would be triggered in an incident. However, although there are many definitions of a traumatic event, what affects one person may not affect another so it’s problematic to be prescriptive with causes. People may be affected indirectly, as witnesses; by ‘near misses’; and through their highly individual interpretation of an event.

In the field of crisis mental health, we tend to use the term ‘critical incident’ rather than ‘traumatic incident’ to reflect this subjective nature of trauma.

A psychological critical incident has the potential to produce a traumatic stress reaction. It is an opportunity to consider the impact of an event. After all, it is the human reaction that we are managing.

There are often indicators that a particular event may prove traumatic for some or all involved in it, for example where:

Individual safety is compromised: there may be actual or threatened injury or death;

Intense helplessness, loss of control or horror is experienced;

High levels of distress are provoked;

There are sudden, shocking changes to ‘normal’ life.

This could however cover a vast range of incidents. As in other areas of business continuity planning, rather than drawing up an impossibly long list of possible causes, look at the consequences: the disruption to people’s psychological balance and functioning.

As well as the single one-off event, psychological trauma can result from multiple or repeated incidents as often found in high risk occupations such as the emergency services. These events can have a cumulative effect but each taken individually may seem to have less magnitude. Again, this may not then trigger an organizational response or consideration of psychological impact. If managers are trained to watch for signs of psychological distress rather than focus on causal events, there is a better chance of getting appropriate help at an early stage.

Employees who are continually exposed to other people’s distress and trauma can develop a range of negative reactions often known as ‘vicarious’ or ‘secondary’ trauma. This can include roles such as health and social care, medical or criminal administrative staff exposed to graphic detail or imagery, journalists, crisis call handlers and caring professionals. Rates of depression among NHS psychological therapists have risen steadily over the past three years and there is a higher than average suicide risk among female health professionals. Again, the chronic, more subtle, nature of this type of trauma exposure, can mean organizations neither recognise nor address it.

In terms of risk management, it’s helpful to take time to thoroughly consider the different types of risks your organization faces from psychological trauma. Although a valuable asset, an Employee Assistance Programme (EAP) may give you a false sense of security. Many organizations believe that, provided they have an EAP in place, then they have considered and addressed all risk. However, this is the equivalent of seeing a trailing wire and saying:

“Oh, we don’t need to worry about that. We’ve got first aiders and there’s the hospital around the corner for anything more serious than that!”

Whilst this comment may sound ridiculous, for many employees at risk of psychological trauma this is exactly the approach that is taken (we hear it often). Yet we can eliminate or reduce many risks: the equivalent of securing the trailing wire.

The impact on business continuity

As human beings, most of us would want to offer the right support to individuals involved in a critical incident. However, where organizational resources are limited, it can be tempting to think that investing in this is a luxury. It may be seen as a bit ‘pink and fluffy’ with no real benefit to the organization.

Whether you are considering proactive or responsive measures, when the human side of risk management and business continuity is handled well there are great benefits for all concerned with a faster return to operational functioning.

If we get it wrong the results can be devastating and not only in terms of the human suffering and the ripple effect on families and colleagues. The organization is also negatively affected by sickness absence, low staff morale, reduced productivity and mistrust and cynicism towards leaders. If the organization is not perceived to care then why should its employees?

In the UK Labour Force Survey, HSE estimates that in 2015/16, 11.7 million working days were lost due to stress, depression or anxiety with the average employee being absent for 24 days. After a critical incident, rates of absence and attrition can peak to critical levels leading to excessive costs of sickness cover or overtime as well as the potential loss of key skills.

Where someone fears losing their job or the respect of their peers, there is great motivation towards denying a psychological problem. The stigma around accessing treatment often means that people, particularly in traditionally macho industries, delay or avoid accessing help for mental health issues. Symptoms may be concealed or sickness explained away as having more culturally acceptable causes – maybe a bad back or virus infection. These sickness absence figures will not necessarily be attributed directly to the critical incident.

There is another hidden cost where reactions go underground and the affected individual is still in the workplace. As symptoms escalate, they are likely to experience deterioration of: focus; decision making skills; concentration; and assessment of risk. In severe cases, there may be drug and alcohol abuse, rage, risky behaviour and even suicidal / homicidal impulses. Ongoing or hidden traumatic reactions may therefore subsequently increase the risk of further critical incidents for the organization.

Following a traumatic event, people sometimes feel they have been left permanently damaged by their experience. Many people will not return to full duties or to work at all. Ensuring effective rehabilitation plans are in place along with the provision of effective treatments can reduce the likelihood of lengthy and expensive capability procedures, potential litigation or reputational damage.

Getting it right makes sound business sense for the organization. However, it’s not just about reducing costs. There are subtle benefits that can be reaped.

In high risk settings, an effective trauma support programme can contribute to improved workplace morale, better working relationships and increased employee satisfaction; resulting in the organization being able to attract and retain high quality workers. A critical incident can fracture a team or strengthen it and where managers have the skills to support their teams, the latter is more likely.

Leadership and morale are both closely linked to resilience and peer support can actually help protect individuals against traumatic stress.

So, if this article has got you thinking, you may be wondering what the key steps are to consider? In our experience, following a thorough assessment of risk, three of the most beneficial areas to consider are:

Proactive training

For organizations that are at heightened risk of critical incidents, training and preparation is crucial. If employees understand the nature of traumatic stress and are aware of helpful coping strategies, they can take their part in healthy behaviours, feel in control of their recovery and have an expectancy of a return to full functioning. This will help them to be resilient and ‘bounce back’ effectively.

Early intervention

Research shows that where those affected are identified at an early stage and provided with clinically effective treatments, including psychological first aid, they will recover more quickly. The earlier the intervention, the simpler it needs to be. Training personnel to deliver good peer and management support can mean less need for outside professionals at a later date. They are well placed to notice changes and there is reduced stigma in accepting support from those who are familiar to us. Trained peer support and psychological first aid will often be enough for the majority of people.

Conversely, the more isolated from his/her peer group, who understand (and perhaps shared) their experience, the less likely the individual is to recover. Mobilising peer support is crucial in the days and weeks after an incident.

Don’t routinely rush to offer ‘counselling’

Knowledge that the majority of people will make a quick, complete recovery with the help of some education and advice can be all that is required by some individuals. In-house supporters can be trained to deliver this and advise on helpful symptom-reducing strategies.
Coming in too early with an offer of counselling stigmatises and pathologises a normal reaction to an abnormal event.

If you do provide access to counselling or therapy perhaps through an EAP, check that they are delivering effective treatments. The National Institute for Health and Care Excellence recommends that “non-trauma focused interventions such as relaxation or non-directive therapy … should not routinely be offered.” Their guidelines set out the treatments that are effective for psychological trauma.

If this has got you thinking about ‘people continuity’ or you’d like to know about the research mentioned, then we’d love to hear your thoughts and questions. We’re always happy to talk trauma!

The authors

Dr Liz Royle: Dr Liz Royle is an international author and speaker with substantial experience of the strategic management of trauma and proactive and responsive interventions for high risk organizations. Her professional experience of trauma was cemented during her time as Senior Welfare Officer for Greater Manchester Police providing 24/7 critical incident interventions to police officers, developing post-incident procedures and managing responses to major incidents such as line of duty deaths and multiple fatalities. She was the lead person for the European Society for Traumatic Stress Studies (ESTSS) Managing Trauma in the Uniformed Services task force for 8 years. Since leaving the police service in 2004, she took her skills and knowledge into the private, corporate and voluntary sectors. Dr Liz Royle has written Trauma Support policies for City Councils, Police Forces and security companies and provided strategic and crisis response support to organizations affected by acts of terror, natural disasters, deaths, violence and serious accidents.

Cath Kerr(CPsychol): Cath is a Chartered Counselling Psychologist, international author, a senior accredited BACP integrative psychotherapist and an EMDR Europe Approved Consultant. She has many years’ experience of working with high risk organizations and clients suffering from Post-Traumatic Stress Disorder (PTSD) and acute trauma reactions including those following serious assaults, road traffic collisions, accidents, traumatic bereavement and historical child sexual abuse. Cath has a management background within the voluntary and private sector, and was involved with local NHS Primary Care Groups to help provide early preventative measures in response to mental health issues. She contributed to the creation and review of policies and procedures to ensure professional working practices. Cath is part of the British Psychological Society Division of Counselling Psychology Qualification Reference Group

Liz and Cath developed KRTS Power to Recover™, an early intervention programme that supports individuals following a critical incident.

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